From open Ivor Lewis esophagectomy to a hybrid robotic-assisted thoracoscopic approach: a single-center experience over two decades

Abstract

Purpose Robotic-assisted procedures are increasingly used in esophageal cancer surgery. We compared postoperative complications and early oncological outcomes following hybrid robotic-assisted thoracoscopic esophagectomy (Rob-E) and open Ivor Lewis esophagectomy (Open-E), performed in a single mid-volume center, in the context of evolving preoperative patient and tumor characteristics over two decades. Methods We evaluated prospectively collected data from a single center from 1999 to 2020 including 321 patients that underwent Ivor Lewis esophagectomy, 76 underwent Rob-E, and 245 Open-E. To compare perioperative outcomes, a 1:1 case-matched analysis was performed. Endpoints included postoperative morbidity and 30-day mortality. Results Preoperative characteristics revealed increased rates of adenocarcinomas and wider use of neoadjuvant treatment over time. A larger number of patients with higher ASA grades were operated with Rob-E. In case-matched cohorts, there were no differences in the overall morbidity (69.7% in Rob-E, 60.5% in Open-E, p value 0.307), highest Clavien-Dindo grade per patient (43.4% vs. 38.2% grade I or II, p value 0.321), comprehensive complication index (median 20.9 in both groups, p value 0.401), and 30-day mortality (2.6% in Rob-E, 3.9% in Open-E, p value 1.000). Similar median numbers of lymph nodes were harvested (24.5 in Rob-E, 23 in Open-E, p value 0.204), and comparable rates of R0-status (96.1% vs. 93.4%, p value 0.463) and distribution of postoperative UICC stages (overall p value 0.616) were observed. Conclusions Our study demonstrates similar postoperative complications and early oncological outcomes after Rob-E and Open-E. However, the selection criteria for Rob-E appeared to be less restrictive than those of Open-E surgery.

From laparoscopic to robotic-assisted Heller myotomy for achalasia in a single high-volume visceral surgery center: postoperative outcomes and quality of life

“…However, achalasia is a rare disorder and even in centers with an active esophageal surgery program [ 30 ] the number of patients is small. Most importantly, the cohorts of patients analyzed are highly homogeneous, and they were operated in a single center by surgeons highly experienced in laparoscopic and robotic-assisted procedures, with a minor learning-curve effect.…”

Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results

“…The well-known robotic benefits together with the adoption of some technical refinements (i.e., supportive stitches) make the hand sewing easier to perform. Nine previous studies [ 9 – 17 ] have reported on widely varying techniques to construct a robot-sewn intrathoracic anastomosis during ILE (Table 4 ). Differences include patient position, number of robotic arms adopted and especially the anastomosis fashioning in terms of the configuration, method, and type of suture.…”

“…The robotic system offers some unique advantages in performing a hand-sewn anastomosis by leading to a more precise and controlled reconstruction as confirmed by some groups who are promoting a return to this type of anastomoses [ 17 , 36 ]. However, the lack of tactile feedback and prolonged tensile effect of the barbed sutures may have contributed to the development of postoperative stricture that occurred especially in the first cases of our series.…”

“…This technology might be particularly useful for the thoracic stage of Ivor Lewis en-bloc esophagectomy (ILE), especially when a hand-sewn esophagogastrostomy is planned. Indeed, although few studies have reported about hand-sewn intrathoracic anastomosis during Ivor Lewis robot-assisted minimally invasive esophagectomy (RAMIE) using widely varying techniques [ 9 – 17 ], all experiences underlined that the robotic technology provided increased suturing capacity, more precise construction and highly controlled anastomosis in a narrow space.…”

Long-term quality of life after hybrid robot-assisted and open Ivor Lewis esophagectomy for esophageal cancer in a single center: a comparative analysis

“…During the past 20 years, our group has accumulated a profound experience in the treatment of esophageal cancer [ 18 , 19 ]. Initially, open Ivor Lewis esophagectomy (Open-E) was performed [ 18 ].…”